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Dr Catherine Itsiopoulos - the Mediterranean Diet

Catherine Itsiopoulos

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Matt Smith
Welcome to a La Trobe University podcast.    I would be your host Matt Smith and our guest today is Associate Professor Catherine Itsiopoulos, Head of the School of Dietetics at La Trobe University.  She will be telling us about her research into the Mediterranean Diet and how simple changes to the food you eat can improve your health.
 
Catherine Itsiopoulos
When you think about Mediterranean diets, there are thirty, forty, as many as there are Mediterranean countries, but the one that has been most researched is the Cretan Mediterranean Diet and it became very popular because of a very large study called the Seven Countries Study, it looked at groups of people from Crete and from parts of Italy and other parts of Europe, including Japan and the US.  They followed these people up for ten to fifteen years and found that the people from Crete had the lowest death rates from heart disease compared to all of the other countries studied, yet their diet was one of the highest in fat.  So they had a very high fat diet but the fat in the diet was predominantly olive oil.  So 95% by weight of the fat in their diet was olive oil.  The diet was also very rich in plant foods, fresh fruits, vegetables, a very heavy duty wholemeal, whole grain bread with seven different grains in it.   There was fish in the diet, legumes was a main source of protein, but low amounts of animal foods – meats, and to some extent, chicken were eaten only monthly.  So, special occasions.  They weren't abundant, whereas plant foods were abundant.  Wine is a key feature of the diet, but only with meals, and generally in between meals, the fresh fruits and the dried fruits and nuts as snacks, were rather than the desserts.  The desserts were special occasion foods as well.  You know, the baklava and all those sorts of things that you associate with the Mediterranean Diet.
 
Matt Smith
That's for Crete.  How much does the other countries in the Mediterranean have in common with this sort of diet?
 
Catherine Itsiopoulos
Well, what the Mediterranean countries have in common is olive oil, primarily, because the olive tree grows throughout the Mediterranean, particularly around the Mediterranean Sea – it's a very hardy plant that will grow in very dry regions, particularly in the southern parts, and that's been a staple fat for Mediterranean countries for thousands of years.  And plant foods – fruits and vegetables a are major feature of Spanish, Italian, other Mediterranean diets, but there is a bit of a difference and I guess the traditional Cretan diet is primarily a vegetarian diet with bread as a main carbohydrate whereas the Italian Mediterranean diet has a high focus on pasta and pizza and those types of carbohydrate foods, which were not traditional in the rural or Cretan style of Mediterranean diet.  So it's that high plant food, not as high in carbohydrate, low animal foods, fish and legumes, yoghurt is another important food, that's been studied throughout the years, since the 1950s and 60s, in lots of studies now around the world.
 
Matt Smith
Why is it that we've got the preconception that a Mediterranean diet consisted a lot of meats and heavy sorts of foods that you can't eat all the time?
 
Catherine Itsiopoulos
That's because restaurants focus on festive foods and they're certainly the preferred foods, and when it's Easter and the lamb on the spit – that's still very traditional.  Or Christmas or someone's name day, or any other celebration, that's when the rich animal foods are eaten in abundance.  And the restaurants serve these foods.  And that's become the common thought, that this is what a Greek Mediterranean diet is about.  Lots of breads, lots of dips and lots of meat.  Whereas traditionally, that only appeared a few times a year, on the table.  So the everyday diet was bean soup, with boiled wild edible greens and lots of olive oil, a little bit of bread, olives on the table, you know, simple meals.  Much, much simpler.
 
Matt Smith
Olive oil seems to be quite a staple.  Why is it that in particular that's good for you, that's good for your health?
 
Catherine Itsiopoulos
Well, olive oil is an unsaturated fat, so mono-unsaturated.  That type of fat is protective for heart disease and that certainly was shown in this very famous Seven Countries Study.  That type of oil in your diet helps to improve the balance between the good and bad cholesterol and there are other important and healthy fats in the diet like polyunsaturated oils which are also important when you are replacing animal fats, saturated fats, with polyunsaturated oils and mono-unsaturated oils.  We know from studies that your cholesterol levels drop, cholesterol is associated with heart disease, so we know that plant oils are better for your heart, and in particular the extra virgin olive oil has got a better type of fat, which is good for your heart and is also rich in anti oxidants, which protect your heart from atherosclerosis, so what anti oxidants tend to do.
Matt Smith
So, was it intentional that the Mediterraneans adopted this type of diet?
 
Catherine Itsiopoulos
Certainly the Mediterranean people highly value the olive tree, and it's part of traditions and it has been for thousands of years it appears, throughout history.  But the simple peasant-style, 1950s, 1960s Mediterranean Diet that's been studied extensively, is because of availability, so it was because of circumstance, not because they specifically chose to have beans, wild greens, and not meat.  If they had more meat, they would eat more meat.
 
Matt Smith
So great that I'm living longer but I'm still a peasant kind of diet.
 
Catherine Itsiopoulos
Yes.  So a lot of migrants that have moved to other countries including the migrants that came to Australia – upon arrival in Australia – started to eat more meats, more dairy foods, more butter, so this may have had some short term effects on their health, but what's happened with the migrants, and this has certainly been part of my research and the group's research is that the first migrants that came to Australia, they've been here for fifty years now, rapidly reverted back to a traditional diet.  Part of the reason was that they wanted to connect with the motherland.  We are studying now people in their seventies and eighties and they have reverted back to a very traditional peasant style of eating.  They don't cook as much meat, they eat more bean-based foods, they fast more, so they go to church more, so that's part of getting older and connecting with religion.  Because of all of that and the impact of religion, they're fasting from animal foods, they're eating more legumes, eating more green, leafy vegetables, growing their vegetables in their gardens, and again, by circumstance, they have a healthy diet.
 
Matt Smith
You've been doing studies of the effects of the Mediterranean Diet on Type 2 Diabetes.  Tell me a bit about that study.  What did you find?
 
Catherine Itsiopoulos
Well, that study, we specifically sought volunteers that were of an Anglo-Celtic background, so they didn't previously have exposure to the Mediterranean Diet.  And we wanted people with Type 2 Diabetes, to see whether the Mediterranean Diet was also beneficial in diabetes, because most of the studies up until the last five to ten years have been on heart disease.  So we recruited people with Type 2 Diabetes of Anglo-Celtic origin, middle aged people, reconstructed the very traditional Cretan peasant-style diet, cooked it, prepared it, and gave it to these people to eat over three months.  They followed the diet very closely because we gave them all the food.  And all the olive oil.  And the snacks and the olives, and pretty much everything they had to eat for that period of time, or the majority.  And what we found after three months is that their blood glucose control improved.  We provided the diet ad libitum, meaning they weren't restricted for energy, for kilojoules or calories, as a lot of studies tend to be, so we said, eat until you're full.  But they didn't gain weight on this diet.  They improved their diabetes control and they reported a very positive change in wellbeing, in mood, in levels of energy that they had, the condition of their skin – a lot reported that they looked younger, and their friends told them they looked younger and their age spots disappeared and the studies that we do nowadays, we're actually looking at ageing, or markers of ageing.  We're also looking at mood, as a major positive benefit of a diet like the Mediterranean Diet.
 
Matt Smith
OK, so it sounds like it has a real positive effect.  Is it a time-consuming diet to maintain though?
 
Catherine Itsiopoulos
Well, if we use traditional recipes, although the salads are fairly quick and easy to prepare, the casseroled foods tend to be slow cooked.  Some recipes are fairly straightforward, others are a bit more complex.  Cooked meals would vary from fairly simple meals, so bean soups can be very quick and easy to make, but some of these slow cooked casseroles are a bit more complex, take a bit more time, and they have a lot more ingredients, so traditional meals can have up to twenty or thirty ingredients, if we count all the herbs and spices and the garlic and onion and the sauce, which are all important components of the Mediterranean Diet.  But if we were to apply those principles in modern day, we could use slow cookers to prepare the casseroles.  There are quick and easy ways that we can incorporate some of the very traditional recipes, but what's rolled out of mine and my group's research are a list of ten key principles.  And they are key principles that individuals can follow to apply the Mediterranean Diet to any type of cuisine.  Things like, use olive oil as the main added fat, in your cooking and in your salads and limit the amount of animal fats that you use.   Make sure you have half a kilo of vegetables every day.  And include leafy greens and tomatoes.  So it seems like a lot but a tomato is 140 grams, a cup of broccoli is another 80 to 100 grams, you could easily make up a half a kilo – it just seems like a lot, but you do need to have more than a slice of tomato and a lettuce leaf in your sandwich.  You really need to think about vegetables for lunch and dinner, no day without fresh fruit, legumes at least twice a week.  Now they don't have to be the traditional Greek recipes – they could be a bean salad, so you open up a tin of beans, you cut up an onion, you might chop up some tomato, dress it with balsamic vinegar and olive oil and it's a quick way to have legumes.  And the legumes from a can are very, very similar to fresh cooked legumes, so you don't lose nutrients by consuming canned, cooked dried beans.  Have yoghurt every day as a snack, it's a good snack, it fills you up and you're not having your cake with your coffee, or something else that might be higher in fat.
 
Matt Smith
And the good thing about being in Australia I suppose is that we had a strong migrant community post-war, and we've got a lot of speciality shops to rely on if we need to, for this sort of food.
 
Catherine Itsiopoulos
Absolutely.  There's an abundance of food.  The ingredients are everywhere.  And the wild edible greens that we're talking about are available in the markets.  The ones that are cultivated like endive, or silver beet, or spinach – so you could replace some of the lesser known ones with the more well known ones.  There's no issue of seasonality pretty much – our foods aren't limited in the winter months as they may have been years ago.
 
Matt Smith
So you've noticed an effect with the food on treating diabetes and with heart disease as well.  What direction is your research taking now?
 
Catherine Itsiopoulos
Well, the newer studies that we're involved in collaboratively with others at Melbourne University and at Deakin University are looking at the impact of the Mediterranean Diet on treating depression, the impact of the Mediterranean Diet on reversing fatty liver, which is a precursor to diabetes.  We've actually got a study which we're about to publish, which looked at the Mediterranean Diet in two modes – one was a slow cooked version and the other one was the high temperature fast-cooked version.  And when you cook foods very quickly under high temperatures in a dry heat, so you're baking and you're browning the meat and you're deep-frying the potatoes and you're browning the bread, you produce these compounds called advanced glycation end products and these AGES are associated with ageing, they're associated with poorer diabetes control, and our study showed, and we've only tested this in healthy young people, that when they went on to a slow cooked diet, the levels of these AGES in their blood dropped, meaning that they were probably healthier.  So we're about to test this in people with diabetes.
 
Matt Smith
So it's a good test to be  involved in.
 
Catherine Itsiopoulos
Yes, well the studies are good because the food's provided but …
 
Matt Smith
A tasty test.
 
Catherine Itsiopoulos
Absolutely.  But the challenge now is to translate those studies into simple and easy to implement principles.  You can take those ideas and implement them in your diet without having to spend two or three hours cooking every night, which most of us don't have.
 
Matt Smith
Catherine Itsiopoulos there, Head of the School of Dietetics at La Trobe University.  That's all the time we have for the La Trobe University podcast.  If you have any questions, comments or feedback from this podcast, or any other, then send us an email at  podcast@latrobe.edu.au.